Medical Tourism: Positive Publicity Is The Need Of The Hour

Dr Saji Salam

What prompted me to write this piece is a news item in a financial daily which quoted ‘experts’ stating the medical tourism industry in India would bring in revenues worth USD 25 billion by 2020.

A Look At The Numbers

Let’s look at some numbers to put this in perspective. The idea here is to not be precise but to give a sense of what numbers we are talking here and what it takes to the numbers projected. One of the best-managed healthcare groups in India with about 6,000 beds, has revenue of about USD 125 million. I do not have the break-up of what percentage of these beds is owned vs managed. However, going with these numbers, my assumption based on crude mathematical projection is that, it would require about 60,000 beds, to reach USD 1.25 billion revenue and 12,00,000 beds to obtain a revenue of USD 25 billion exclusively from healthcare services.

Let us look at some of the actual numbers from the tourism industry as well. The numbers may be a little dated but this is what it looks like. In 2003, about 2,726,000 tourists visited India and the revenue from the same was USD 3.5 billion. Well, if that many relatives of patients (about 3 million) travel to India, we could manage another USD 3.5 billion from tourism services. Barring inflated projections like these, it remains a fact that medical tourism in India is a growing trend.

Segmentation Of The Patient Population

Currently, the bulk of the patients come to India from neighbouring countries such as Bangladesh, Pakistan, other Asian countries, Africa and the Middle East. In many cases, the driver for cross border care is a question of quality of care than cost itself. The quality of care that we provide in India is simply not available in some of the neighbouring countries.

The second segment is the segment of patients sponsored by the governments in their respective countries such as Middle East and Africa. For those governments, India is relatively a cost-effective option compared to Europe or the US. Private patients (not sponsored) from these countries look at India as value for money option vis a vis Europe and US. Moreover, post 9/11 there has been a dramatic drop in patients from Middle East to the US.

The market segment that the healthcare industry is targeting is the patient population from Europe and the US. There are several patients of Indian origin residing in UK and US, who are already using the services of hospitals in India, when they are on vacation etc. Apart from this we have the widely-publicised cases of patients from the US and Australia.

True, these countries do have an increasing population and the healthcare systems are on the verge of collapse. Even though it is economically viable for some of these governments to officially bless shipping of patients abroad, it is the political viability of such a decision that may need to be worked on. Would a political party in power in Europe/US would want to face the next election as the pioneer of shipping patients to ‘third world countries’?

We may want to recognise that a strategy which works for attracting patients from Bangladesh may not work for patients from Britain, since the expectations and drivers are different. The industry think tank may want to recognise the diversity in the medical tourism patient population and devise niche strategies to tap into each of the segments.

Competition

What is a good reason for an average senior citizen in the US to fly 18-20 hours to get his hip replaced? Can he even travel with hips in such bad shape? Obviously if he is not covered by insurance and cannot afford the same in US he has to look at options. What if this can be done in Mexico or Costa Rica at comparable rate and a shorter flight?

I am not an expert of the patient flow patterns to competitor locations such as Hong Kong, Singapore, South Africa, Costa Rica, Mexico, the Caribbean and emerging destinations such as Dubai. Per Becca Hutchinson’s article on a University of Delaware publication looks like this is what is going on in competitor markets.

South Africa draws many cosmetic surgery patients, especially from Europe, and many South African clinics offer packages that include personal assistants, visits with trained therapists, trips to top beauty salons, post-operative care in luxury hotels and safaris or other vacation incentives. Because the South African rand has such a long-standing low rate on the foreign exchange market, medical tourism packages there tend to be perpetual bargains as well. Bangkok Phuket Hospital is the premier place to go for sex change surgery. In fact, that is one of the top 10 procedures for which patients visit Thailand.

Argentina ranks high for plastic surgery, and Hungary draws large numbers of patients from Western Europe and the US for high-quality cosmetic and dental procedures that cost half of what they would in Germany and America. Duba is scheduled to open the Dubai Healthcare City by 2010. Situated on the Red Sea, this clinic will be the largest international medical centre between Europe and South East Asia.

The Indian healthcare industry needs to examine the factors that have made these medical tourism destinations popular.

Challenges

There are definitely areas for improvement as the Indian healthcare industry starts marketing services to newer patient segments. A key difference in healthcare services in India, unlike the IT sector is the critical role the government has to play to utilise medical tourism opportunity to its best. Some of the areas for improvement, to make India a global healthcare destination are:

Image Makeover

Despite the success of India in the IT market, perception of India in the eyes of the target audience has to change dramatically. The predominant image of India the average senior citizen in Europe (who is a target customer) has in his mind is picture of pre-independent India. To transform those images and present an image of India where he can trust Indian surgeons with his heart, his face and hips is a challenge (outsourcing your heart surgery is a lot different from outsourcing a software code!). To the average senior citizen in the US, it is more of a challenge, since to many, India is still a land of snake charmers and cows in traffic, a land far far away.

Perception Of Quality Of Care

Though one may argue against this, an average patient half a world away perceives the quality of care based on the perception of the country’s image as a whole. The patients may have a hard time comprehending that the quality of care in India can be comparable to the US. One way to get over this is for hospitals to follow international healthcare accreditation standards. Would a patient be willing to trust his heart, kidneys, hips and face if there is an iota of doubt regarding the quality of care? (This segment of high yielding procedures is where the Indian medical tourism market is looking forward to for better profits). In fact, there have been cases of plastic surgery gone bad, particularly from Mexican clinics in the days before anyone figured out what a gold mine cheap, high-quality care could be for the developing countries.

Scalability Of Healthcare Infrastructure

The first question that comes to my mind is whether India can scale up to address the increasing patient mass. Do we have enough specialists and super specialists? We may have enough and more of entry-level physicians, but how are we placed with regard to doctors with postgraduate qualifications? What is the reality on the group with regard to paramedical staff? How is the attrition among nurses due to demand abroad?

I am sure these questions are being asked. The other question is the sheer number of beds and physical healthcare infrastructure required. On a different note, from a social perspective, would there be enough doctors and infrastructure left to treat the not so ‘profitable’ Indian patient?

Role Of IT Standards

Finally, adopting and adapting of IT systems and standards that are in vogue in the developed world would be required to ease the administrative processes involved in cross-border care and integration with the medical records in the country of origin.

How Can The Government Facilitate?

The role of the government is critical in various areas if we need to scale the existing model. Some of the areas where government can and should act are:

Medical Education

It is high time that the government really looked hard at the demand supply situation of human resources in the healthcare sector and recalibrated the supply of specialists and paramedicals in the country. This would mean changes to policies on post- graduate medical education, nursing education etc.

Infrastructure

Quality of healthcare service can be limited by traffic and hartals. The last thing the fledgling medical tourism industry in India wants is bad press on a couple of foreign patients in ambulances that were stuck in traffic for several hours due to a political party’s rally. From airports, and high ways, and hassle free environments for patients’ relatives, there is quite a bit where improvements can be made on the infrastructure side.

Law And Order

Law and order and general sense of security are definitely areas for improvement. For all the gold in the world, I might want to get my hip replaced in nearby countries, which are infested with and mines and missiles waiting to take off.

Legal Infrastructure & Ethics

What is the mechanism for international patients who seek legal redressal for service gone bad? How long would it take for resolving the same in India? Is our legal infrastructure geared up to handle healthcare specific issues in a speedy manner?

Privacy Of Patient Information

One area that is understated in discussions around healthcare services in India is confidentiality of patient data and regulations related to privacy and security of patient data in India. A good start would be to adopt HIPAA standards in India.

The writer is Chairman of HL7 India.
email: saji.salam@cognizant.com